Provider Demographics
NPI:1629166608
Name:CHAISSON, DOROTHY (LCSW)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:CHAISSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:DOROTHY
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:169 PARK ROW
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011
Mailing Address - Country:US
Mailing Address - Phone:207-729-5426
Mailing Address - Fax:207-725-2473
Practice Address - Street 1:169 PARK ROW
Practice Address - Street 2:SUITE 7
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011
Practice Address - Country:US
Practice Address - Phone:207-729-5426
Practice Address - Fax:207-725-2473
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC8345104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
047729OtherANTHEM
345589OtherMANAGED HEALTHNET
2106228OtherCIGNA
2106228OtherCIGNA